Introduction: Palliative care (PC) aims to improve symptoms and QOL in advanced HF, in part through medication management. However, the impact of PC on polypharmacy (≥5 medications) in advanced HF remains unknown.
Hypothesis: An interdisciplinary PC intervention that significantly improved QOL (Pal-HF) will show reduced polypharmacy in the intervention arm compared to control.
Methods: Pal-HF was a randomized controlled trial of standard HF care (N=75) versus standard care plus an interdisciplinary PC intervention in patients with advanced HF (N=75). The intervention assessed capacity for reducing medication burden and provided phone access for medication-related concerns throughout the study. General linear mixed models were used to evaluate associations between treatment arm and medication burden at 2 and 6 weeks, and 3 and 6-month follow-up visits.
Results: The median age was 72 (62-80) years, 47% were female, 41% were black, 48% had ischemic etiology and 55% had an EF= 40%. Medication counts separated at 12 weeks by treatment arm for both HF and PC medications (Figure). The intervention group showed a non-significant reduction in HF medications (8 vs 11; p=0.26), PC medications (4 vs 6; p=0.27), and overall medication burden (14 vs 20; p=0.23) as compared to control at 6 months.
Conclusions: Pal-HF improved QOL in patients with advanced HF. Though polypharmacy increased over the course of care, medication burden was lower in the intervention group over time as compared to control. Palliative care interventions in HF, designed to improve symptoms and QOL, may also ameliorate underlying issues that trigger polypharmacy (e.g., depression and anxiety and pain). More work is needed to understand the relationship between polypharmacy and QOL in PC interventions.